Page 43 - Rx Drug Plan review for John

11/14/21, 9:56 AM MSRG_II
HUMANA INSURANCE COMPANY - (888) 310- Methodology: AA
8482

90 $2,226 $2,422 $3,085 - $3,148 $761 $2,533 $683 $1,280 $1,855 - $1,834
Restrictions Effective Date: 06/01/2021

INDEPENDENCE AMERICAN INSURANCE Methodology: AA
COMPANY - (866) 951-0679

0 $1,930 - - - $2,348 - $1,945 - - - - $1,581

Restrictions Effective Date: 04/01/2021
INDIVIDUAL ASSURANCE COMPANY, LIFE, Methodology: AA
HEALTH & ACCIDENT - (888) 524-3629

0 $2,344 - - - $3,173 - $2,518 - - - - $2,147
Restrictions Effective Date: 09/01/2020

LOYAL AMERICAN LIFE INSURANCE COMPANY - Methodology: AA
(866) 459-4272

180 $2,264 - - - $2,906 - $2,241 - - - - $1,613
Restrictions Effective Date: 08/01/2021

MANHATTAN LIFE ASSURANCE COMPANY OF Methodology: AA
AMERICA - (800) 877-7703

0 $1,756 - - - $2,169 - $1,766 - - - - $1,500

Restrictions Effective Date: 05/01/2021
MUTUAL OF OMAHA INSURANCE COMPANY - Methodology: AA
(800) 667-2937
0 $1,651 - - - $2,969 $688 $2,497 - - - - $1,884

Restrictions Effective Date: 07/01/2020

MUTUAL OF OMAHA INSURANCE COMPANY - Methodology: AA
(800) 667-2937

0 - - - - - - - $476 - - - -
Restrictions Effective Date: 02/28/2020

NATIONAL GUARDIAN LIFE INSURANCE Methodology: AA
COMPANY - (800) 548-2962

0 $1,975 - - - $2,361 - $2,074 - - - - $1,629

Restrictions Effective Date: 10/01/2021
NATIONAL HEALTH INSURANCE COMPANY - Methodology: AA
(866) 916-8816
0 $1,636 - - - $2,160 $671 $1,825 - - - - $1,484

Restrictions Effective Date: 09/01/2019
OXFORD LIFE INSURANCE COMPANY - (800) Methodology: AA
308-2318

0 $2,928 - - - $3,813 - $2,062 - - - - $2,027
Restrictions Effective Date: 10/01/2021
https://interactive.web.insurance.ca.gov/apex_extprd/f?p=111:31:11502158414098::NO::P31_SUBMIT:Y 3/4